Medical Case Manager - Delaware (New Castle County)
$72.7k - $116.6kHighmark Health
- # Medical Case Manager - Delaware (New Castle County)Applyremote type: Remotelocations: DE, Working at Home - Delawaretime type: Full timeposted on: Posted Todayjob requisition id: J283767## **Company :**Highmark Inc.## **Job Description :****JOB SUMMARY**This is a full-time hybrid work from home and community-based position requiring frequent travel within the assigned territory. A portion of this role involves working directly with members where they are - in-home, hospitals, PCPs, etc. This job assures that members with complex medical and/or psychosocial needs have access to high quality, cost-effective health care. Assists in the holistic assessment, planning, arranging, coordinating, monitoring, evaluation of outcomes and activities necessary to facilitate member access to healthcare services. Advocates for the most appropriate care plan using sound clinical judgment; accurate planning, and collaboration with internal and/or external customers and contacts. Follows established regulatory guidelines, policies, and procedures in relation to member interventions and documentation of activities related to the member’s care and progress across the continuum of care. Facilitates and/or participates in interdisciplinary and/or interagency meetings, when necessary, to facilitate coordination of services/resources for members.**ESSENTIAL RESPONSIBILITIES*** Communicate effectively while performing customer telephonic interviewing and communication with external contacts.* Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.* Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States* Educate members to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes.* Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care.* Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs.* Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member.* Develop an individualized plan of care designed to meet the specific needs of each member.* Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated.* Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services.* Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention to develop a realistic plan of care.* Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination.* Maintain a working knowledge of available community resources available to assist members.* Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible.* Work within a Team Environment.* Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services to enhance professional knowledge and competency for overall management of members.* Participate in departmental and/or organizational work and quality initiative teams.* Case collaborates with peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts.* Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources.* Foster effective work relationships through conflict resolution and constructive feedback skills.* Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable.* Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served to foster constructive and collaborative solutions to meet member needs.* Other duties as assigned or requested.**QUALIFICATIONS****Minimum*** Bachelor’s degree in nursing or RN certification in lieu of bachelor's degree or Master’s degree in Social Work, Counseling, Education, or related field and 3 years' experience in Acute or Managed Care/ experience with Medicaid or Medicare populations. OR* Bachelor’s degree in Social Work with five years’ experience in Acute or Managed Care/ experience with Medicaid or Medicare populations**Preferred*** Experience working with high-risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics* 3 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations.* Bilingual English/Spanish language skills.* Case Management Certification**LICENSES AND CERTIFICATIONS****Required*** Licensed Social Worker (LSW)-Non-Specific - State (OR) Licensed Professional Counselor (LPC) - Non-Specific State (OR) Licensed Bachelors Social Worker (LBSW) (OR) Licensed Clinical Social Worker (LCSW) - Non-Specific (OR) Licensed Master Social Worker (LMSW) Non-Specific (OR) Licensed Graduate Social Worker (LGSW) (OR) Licensed Certified Social Worker (LCSW) (OR) Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Incumbents in the role prior to 1/1/25 who are not currently licensed must obtain licensure by 12/31/27.**Preferred*** None**Skills*** None**SCOPE OF RESPONSIBILITY**Does this role supervise/manage other employees?No**WORK ENVIRONMENT**Is Travel Required?No***Disclaimer:*** *The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.****Compliance Requirement:*** *This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.**As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.***Pay Range Minimum:**$72,700.00**Pay Range Maximum:**$116,600.00*Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.*
- J-18808-Ljbffr Highmark Health
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Medical Case Manager - Delaware (New Castle County) in New Castle, DE vacancy
$43k
...at $43,000.00 This position is for New Castle County Successful candidates will have the... ...Familiar with community based services in Delaware. ~ Possess individual vehicle and... ...and detail oriented, with good time management skills. Ability to work independently...SuggestedWork at office- Merakey is seeking a Case Manager to join their Children’s Behavioral Health Program in New Castle County, Delaware. The position involves coordinating resources for clients and... ...includes comprehensive benefits, including medical coverage and tuition reimbursement. #J-1...Suggested
- ...Deputy Attorney General to serve as Assistant Unit Head for the New Castle County Felony Trial Unit. This critical role requires strong... ...criminal prosecution, overseeing both individual caseload and team management. The ideal candidate will take part in mentoring staff and...Suggested
$50.2k
...interventions related to the improvement of medical care and costs. Essential... ...with the goal of impacting members’ self-management skills and positive behavior changes which... ...psychosocial intervention. Develop/implement case or condition-specific plans of care and/or...SuggestedTemporary workWork at officeLocal areaRemote workFlexible hoursHighmark
Wilmington, DE2 days ago- We are seeking a Case Manager to join our Children’s Behavioral Health Program serving clients in New Castle County, Delaware. Requirements At least 1 year of experience working with... ...call coverage. Benefits Comprehensive medical, dental, and vision coverage, plus...SuggestedWork at officeMonday to FridayWeekend workAfternoon shift
- Highmark Inc. in Delaware seeks a Medical Case Manager for a full-time hybrid role requiring travel within the territory. The position supports members with complex medical and psychosocial needs by coordinating care across providers and settings. You'll educate members...Remote jobFull time
$21 per hour
Holcomb Behavioral Health Systems - A Chimes Company is seeking a Case Manager for Behavioral Health Services in New Castle, Delaware. The role focuses on coordinating care under the Recovery Model and developing strength‑based service plans for up to 30 clients. The position...Hourly payMonday to Friday$20.67 per hour
...everything we do. We are seeking a Case Manager to join our Children's... ...Program serving clients in New Castle, Delaware . Earn $20.67/hour... ...standards set by Merakey, county MHDS/CASSP, OMHSAS, and other... .... Benefits Comprehensive medical, dental, and vision coverage...- ...the quality of life of Delaware citizens by promoting... ...assessment and case management of specialty court clients... ...with accessing medical care, housing, education... ...condition of hire. All new hires are required to... ...locations in Kent or New Castle County. Benefits To learn...Work experience placement
$21 per hour
...serve. Job Details Job Title: Case Manager - Behavioral Health Services... ...:00 am - 5:00 pm Location: New Castle Program: Behavioral Health... ...for Lehigh and Northampton counties) A high school diploma and... ...Benefits Competitive Pay Medical, Dental, and Vision Insurance...Hourly payMonday to FridayFlexible hours- ...Join the VitalCore Team in Delaware! We're people fueled by passion... ...Correctional Institution in New Castle, Delaware! Must hold a substance... ...Day, and Christmas Day ~ Medical ~ Dental ~ Vision ~... ...crucial role in addressing and managing substance abuse issues among...Temporary workLocal areaFlexible hours
VitalCore Health Strategies
New Castle, DE4 days ago - ...a passionate Substance Use Disorder Program Clinical Supervisor to join our team in New Castle, Delaware. This position entails clinical supervision, treatment planning, and management within our correctional facility. Candidates must hold a relevant master's degree and...
- Premierptsp is looking for a motivated full-time PT Clinic Director for their New Castle, DE outpatient clinic. This position requires a graduate of an accredited Physical Therapy program along with a Delaware PT license. Clinic Directors will assess patients, develop treatment...Full time
$36 - $40 per hour
...A-Line Staffing is now hiring RN Case Manager in New Castle County, Delaware . RN Case Manager Highlights Schedule: Monday – Friday, 8:00 AM – 5:00 PM... ...individuals to determine level of functioning. Perform medication reconciliation as part of member assessments....Hourly payImmediate startMonday to FridayA-Line Staffing Solutions
New Castle, DE1 day ago- ...Medical Director Serves as the senior physician executive for the Division of Substance Abuse and Mental Health (DSAMH), providing... ...psychiatric and behavioral health services statewide, including the Delaware Psychiatric Center. Oversees medical staff and clinical...
$35 per hour
...RN Case Manager – Weekender - Day Shift Saturday & Sunday (Hours: 8a-8:30p plus one rotating Friday shift (4p-8p). Newark, DE... ...patient progression. About Us ChristianaCare is located in Delaware and is one of the country's most dynamic healthcare...Price workLocal areaRelocation packageShift workRotating shiftWeekend workDay shiftChristianaCare
Newark, DE51 minutes ago$19.5 per hour
Brandywine Counseling and Community Services in Wilmington, Delaware is seeking a Case Manager for our Hep C program. The role involves facilitating client referrals, conducting counseling sessions, and overseeing case management procedures. Qualified candidates must possess...- ...) is to improve the quality of life of Delaware citizens by promoting health and well‑being... ...is responsible for assessment and case management of specialty court clients referred by... ..., and assisting clients with accessing medical, housing, education and other services...Casual workSeasonal work
- DE is seeking a dedicated professional for case management of specialty court clients. This role involves assessment, client interviews, reporting... ...a satisfactory criminal background check. The State of Delaware values diversity and encourages applicants from various...Casual workSeasonal work
- A developmental services provider in Wilmington, Delaware is seeking a Case Manager for their Children's Behavioral Health Program. The role includes coordinating resources for clients and their families, ensuring compliance with documentation, and monitoring safety. Benefits...
$115k - $135k
...: No Coverage Area: New Castle, Kent, and Sussex counties Salary: $115k - $... ...location. current Delaware RN License Required... ...hospice, home health or case management experience, or equivalent... ...Our benefits include: Medical, dental, and vision coverage...Full timeTemporary workWork at officeLocal areaRemote workFlexible hours$17 per hour
...DFS Liaison / Case Manager Since 1985 Brandywine Counseling & Community Services, Inc. (... ...including evenings and weekends Location New Castle County: Churchman Corporate Center: 92... ...package for this position includes Group medical, dental, and vision coverage with low...Work at officeMonday to FridayAfternoon shiftBrandywine-Counseling-and-Community-Service
Wilmington, DE2 days ago- ...p-12a Mon-Fr 4p-12a ABOUT THE ROLE The Case Manager is a bachelor’s level paraprofessional with... ...transition of clients to and from the Delaware Psychiatric Center and other acute care... ...Outlook, Power Point. Agency Electronic Medical Record and other software programs....Full timeInterim roleLocal areaImmediate start
- ...the quality of life of Delaware citizens by promoting health... ...Center. Oversees medical staff and clinical programs... ...status of assigned cases; takes part in conferences... .... Medical Director Manages through subordinate supervisors... ...and evaluates new/revised programs/services...Private practice
$231k - $280k
...Medical Director Vivo HealthStaff is actively recruiting for a Medical Director position... ...history and physical assessments on new participants and perform event-based and... ...Up to 10% bonus potential. Practice Management support to help establish your practice....Permanent employmentTemporary workRelocation$36.24 per hour
...Registered Nurse-Case Manager Job ID #2046386 | Share About this Role In your role as Case Manager,... ...Job details $36.24 / hour Wilmington, Delaware New Profession: Registered Nurse Facility Type:...TotalMed Staffing
Wilmington, DE2 days ago$85k
...mental healthcare services focused on evidenced-based, medically driven treatment services for children,... ...Supervisor (RN / Social Worker)- Chadds Ford, PA Case Manager Long-term Care - New Castle County, Delaware Wilmington, DE $57,700.00-$107,800.00 4 days ago Wilmington...Full timePart timeReliefRemote workRelocation packageFlexible hoursLifeStance Health
Newark, DE2 days ago$47.5k - $60k
...access to vital services. We have an exciting opportunity as a Case Manager. In this role, you will provide support to empower adults with... ...management preferred. Reliable car required for field work. Delaware residency required. Home‑visits required. Possible travel may...Work from homeJEVS Human Services
Wilmington, DE2 days ago- ...The Certified Case Manager (CCM) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient's rehabilitation experience. The CCM coordinates and advocates for the...
Encompass Health Rehabilitation Hospital of Middletown
New Castle, DE5 days ago - ...Case Manager The Case Manager is responsible for assessing participant needs, coordinating and implementing individualized service plans... ...coordination activities. Connect participants to behavioral health, medical, housing, employment, transportation, educational, and social...Work at officeLocal areaAfternoon shift
Resources For Human Development
Bear, DE4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medical Case Manager - Delaware (New Castle County). Be the first to apply!
Related searches
- clinic supervisor New Castle, DE
- health services manager New Castle, DE
- clinical director New Castle, DE
- occupational health manager New Castle, DE
- director of health information management New Castle, DE
- medical coding manager New Castle, DE
- clinical manager New Castle, DE
- medical director New Castle, DE
- psychiatry medical director New Castle, DE
- hospital supervisor New Castle, DE